HomeMy WebLinkAbout10-13-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of ~"'/ Q/`~Q ~ < ~ A'I/l ~C /'1 ~ ~ ' ~ `I " ~ 1
~~ File Number ~/
also known as -
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
Deceased Social Security Number /5c~- ~ ~J - ~ o gd
l.~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~.X.C='CUT~°- ITX named in the
last Will of the Decedent dated _ /~• ~?~ OyL and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _
^ B. Grant of Letters of Administration
(y applicable, enter.• c.t.a.; d.b.n.c.t.a.; pendente file; durante absentia; durante n:i,to+•itate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following use (if any) heirs: 1
Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) - ~ -. rf
Name ne,...:,._..L:_ ; ~ _,~• ....J __~
_ ~ i...r_1 _... ~::.:, .
_ ~.. ..J ~ ~,: Tom, _..5.. ,
(COMPLETE INALL CASES:) Attach additiotta[ s/:eels if necessary. : "^ ~~=~ ~ ~} -°- `~c-
Decedent was domiciled at death in~ Y' ~ '''
County, Pennsylvania with his /her last principal residence at o5. GIJ.,QS'f
~e,,st st,•ee[ address, town/city, township, counq~, state, zip code)
Decedent, then ~ years of age, died on /~-~ Uq at ~;",j/ P/L/ -
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$ ~t~qp _
~1`
~s
Fa-n, R6Y-01 rep,. Jo.J3-o6 Page 1 of 2
sitrtated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Oath of Personal Representative
COM~10NtiVEALTH OF PENNSY'LVANLA
COUNTY OF
SS
'The Petitioner(s) above-named swear(s) or affirnz(s) that the statements in the foregoing Petition are hue and con~ect to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
•
Sworn to or affirim~ed and subscribed
/ -~-~..~
before me the day of
For the Register
Si~natttre oJPerso,ia! Representative
Signature of Personal Representative
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Signature oJPersonal Representative ~ ~:~
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File Number: ~ ' ~~t - a9 sew = 4 m~ ~,~.; ~ ~ ~~~.~
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Estate of 3 ~ ," 'i
Social Security Number: 152.- ~Jr- -~(p q g Date of Death: IO -~ -- ~ ~
AND NOW, l3 ,o2DV , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~Q
are hereby granted to ~ ~ ~1~5,
in the ahnvP actata
aild that the instrument(s) dated `~ -- 2 g -(~
described in the Petition be admitted to probate and filed of
FEES
Letters ............... $ D • U
Short Certificate(s) ........ $ ~ •(~
Renunciation(s) .......... $
w ~ V--- ... $ I S cx~
J~ ... $ II~,OI~
~t~.-E-omc~„~.~ c~ ... $ ~ . btu
... $
... $
... $
... $
... $
... $
recor the last it and Codici s)) of Decedent.
Re 'ster ojWills
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
TOTAL .............. $ •(X)
turn, Rw-v~ rev. 1a13.ur Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 157303 8
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~'` d . 5~ 200
Local Registrar Date Issued
_______.~.._W__ ______________
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H1o5-113 REV 11/'1008
TYPE /PRINT IN COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH ~
..r.. ,• ."..) i ..."`)
• VITAL RECORDS
PERMANENT
BLAC ~
K INK
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
1. Name d Decsdem (Fkn, midde, ten, suHlx)
Martha E. ~
5. Ags (Lett Birthday) Under 1 i
tlonme
92 Yrs.
ab. Counry d Deem
C~anberland
STATE FILE NUMBER
2. Sex 3. Sodel Searrhy Number 4. Dale d Deem (Month, day, year)
F 152 - 05 - 8698 10 3 2009
Under 1 der 8. Dak d &nh MaMh, 7. C and elate a 8e. Pleoe d Duch Check ate
Flarxe Aixasc
8c. Gry, 8oro, Twp. d Deem
Carlisle Boro.
Khtd d Wark KkM d Brrektees / Irtdu
Supervisor .JI Welfare
18. Decedent's Medtrtg Address (street qry /town, state, zip code)
507A S. West St.
18. Fether'b Name (Ebel, mfdde, last
F.c1~,vard H.
20a. Mfamerd's Name (Type /Print)
1917 Hazleton, IN
Bd. Fadlky Name (If not insthutlon, give street end number)
507A S. West St.
12. wee Decedent aver M the 13. Ikcedenrs Edaatwrt (Spegly
U.S. Amted Faae7 Elemenery / SecerWery (a12)
^ Yea 1~] No
Decedents PA
Actual Residence 17a. Slate
„~. ~,,,,~ C-~nberland
Hospital: Other:
^ Inpefient ^ ER I Oulpatbrd ^ DOA ^ Nureing Home ~] Resfdsrta ^ Other - Spegly:
9. Wu DacederN d Hkpagc Origin? ®No ^ Yea 10. Rea: Arttedan Indian. Bledc, While, etc.
pi Y•a aP•aN cubes, (SP~h)
Mexican, Puerto Ricert, em.) White
higlten grade contpbted) 14. Mahn StaNe: Marred, Never Married, 15. Survivktg Spouse (Ii whe, give maiden name)
3 Hoge (1.4 a 5+) Wkbvred, Divorced (SyecYlyj
widowed _
Dw Decedent
Uve in a 17c. ^ Yes, Decedent Wed in
Towrahp7 Twp.
t)d. QTIo, Oeaderd Lived wdMn Carlisle
Achtd LhrYfa d Ciyl Bao
19 Norval Name
21a. Method d Deposhion
^ ^ ~ ®Crerttetlon ^ Danetion 21 b. Date of Diapattbn (Morten, day, year)
,--~ ~ d Cwee d Dsam7 Natural ^ Flomigda
^ Yu ldNo ^ Yes ^ No ^ Accident ^ Pending Inveetlga8on
^ Suldds ^ Could Not be Detsrmetsd
Item 27. PeA I: Eraer the one and sxamplu) xkree kten
1~9~.ffi-DNS - dbuaea, ir~area, or sompMcellona • mat drec8y eased the deem. DO NOT eMar tenninel evenla such as cardiac arrest, r Onset to Dum
rupirnory arras, a veMrlcuer obrMaten wdtltout ntowirg the etbegy. Lin only ate cetme an each line. t
U$E (Fmsl) dswae a r
I"deem ~Y /J ~,.~ /.I- t
-~ a. w.
r
Due to (a m a anaeq.er,a oq.
Yet catd8orw, Y arty, b. i
(d ace a~ ~t Initlabd tf e a Due to (a u a cxtnaequertce ot1:
evems roauhkg~m deem) LAST. c. t
Duero(aue t
ol): t
d. r
30e. was an Auropay 30b. were Autopsy Findhrga 31. d Deem r
Pedomted7 Avelebe Prbr to Compedat 1-,/ 32a. Date d Irqury (Monet, day, year) 32b. Desaihe How Iryury Occurred
. s (Fkn, ntWtle, meklan euments)
Mabel D. Sisson
lob. InfomteM's Mailing Addreee (Street dry /town, state, zip coda)
606 Woodland Ave., Mt. Holt S Tin s, PA 17065
21 c. Plan d Dieposkbn (Name d cemetery. cremarory or other place) 21 d. Locetlan (City/tam, see, zp code)
Evans Cremation Services Leola PA
Name and Address d Fadliry
fain Brothers Funeral Ham, Inc., Carlisle, PA 17013
~~) 23b. Licerme Number 23c. Date S daY~ Yeed
heats 24.28 mutt bs completed by person 24. Time d Deem 25. a Prat~p~a~ Deed ( day, year) ~
who pratounae duet. ~ , ~// /~ // p /~r ~~ ~ '~ ~,~+ 28. Wu Cese Refe to Medal Examiner I Coroner fa a Reason Omar men Crematlon a Donatlon4
I _ M. Lj~.Q E3`'~ <,C dC~'`l ^ Yea ~No
CAUSE OF DEATH (Sts InsMUCtI
^ Other Budei Removal from State r Wu Cremallon a Donetlon Autltorizsd
h Meacd Exrntrter/Corottera ®Yes^ No 1 0 5
22s. SlpaNro d Few Licensee (a 22b. Lkense Number
~ FD 012633 L
Complete hems 23a~c only when art8ying 23a. To the beat d rred at dte tlma,
phycigsrt a nd evailebie at tka d duet m ~ s h
artYy suss d deem. ~
but rat resuhkg in me urtderlyktg auae given in Pad I,
^ Yes ^ ProbeWy
® No ^ Unknown
2s. raaFf~male:
Ice Nd pregnant wllhin past year
^ Pregnant et tlrrte d deem
^ Not pregnant but pregnant wdhe 42 days
of deem
^ Not pregnant tad pregnant 43 days ro 1 year
belae deem
^ UMaown h pregnant within me pest year
32c. Place d ktjury: Horn. Farm, Street Fagay,
OfAce BuNdYrg, etc. (Sped/y)
Time of Injury 32e. Injury at Work? 32f, h Treneportetlon Injury (Specllyl 32g. Lacatlon d inlurY (Street qty /tam, state)
^ Yee ^ No ^ Ddvar/Opereta ^ Passenspr ^ PedesMan
M.
33e. Certller (dtegc any one) OdIBr • '•'
• phyetoen (Physiclsn arthyktg cause d deem when artoRtsr phycN;ert has prortotxtad deem and ) 33b. Tfde d Cartller
Toth bap d my lawwledg•, death occutnd dw ro dte awe(s) and manner u speed _ _ _ _ _ _ - tW Lem 23
Pro^ourwirroaraoartlMkwPM'•Mrn(Phyddennom -------------------. -
To eM beet d my IaawMdpe, d..tlt oaurred n the d~ plea~irtd m•uae d deem) 33a Uartse Nrxriber 33d. Dale S
awe(s) and manner as ehMd_ _ -' _ _ Igrted (MoM
• iNedkelExemkter/Coroner ------------^ ~ / /O~S
,Wrj, On me but d exeminetlon and / a Inveetlgelron, In my opinion, loam occurred n ttw thrte, deN, and place. and dw to tM
~ ceuee(s) end manner u tteta~ ^ 34. Nerve and Address d Person Who Completed Cause d Death (keen 27) Type /Print
35. Rattlttrel and n /~
w e FYed (Monet, day, yu~ C , ~ r i S ~ n~,(f .~ ,J,CJ" ~
~ ~ ~ ~.c~i~,~De LEI I I ~ I 1 I C> I ~ a~ o „e,, ls,.+,.. sf Gx~r '~
~~ ~
DiapalYort Pemdt No ~- (~~~~~~_
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WILL OF `- '
~
'~ ~~
" { F
MARTHA E
SERVIENTE ~ `
=~~ ~ ~ -~~.-
'
`~~
.
_ .
.
I, Martha E. Serviente, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my last Will and hereby
revoke all prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall
be paid from my residuary estate as soon as
practicable after my death.
2. I direct that all inheritance, estate, transfer,
succession and death taxes of any kind
whatsoever which may be payable by reason of
my death shall be paid out of my residuary
estate.
3. I direct that my entire estate be distributed as
follows:
A. I leave all of my property, real and
personal, to my children Michael A.
Serviente, Edward B. Serviente, Sandra
D. Weber, Patricia Fischer, and Tony
Serviente in equal shares.
B. Should Edward B. Serviente predecease
me, his share shall lapse and pass in
equal shares to my children who survive.
C. Should Michael A. Serviente, Sandra D.
Weber, Patricia Fischer or Tony Serviente
predecease me, their living children shall
take their parent's share in equal parts.
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
4. I appoint Patricia Fischer as Executrix of this my
last Will. If she should predecease me or cease
to act in such capacity, I appoint Sandra D.
Weber as alternate.
.~~. _- ~ S~ ~,
5. The Executrix of this Will shall have the power to
distribute my estate in kind or in cash, or partly in
either.
6. I direct that no Executrix acting under this Will
shall be required to enter bond in any
jurisdiction.
IN WITNESS H , I have hereunto set m hand t ~ g ~~
day of 2004y his
~~
a~J~ ~.
Martha E. Serviente
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
The preceding instrument consisting of this and two
other pages was on the day and date hereof signed, published
and declared by Martha E. Serviente, as and for her last Will in
the presence of us, who at her request, in her presence and in
the presence of each other have subscribed our names as
witnesses hereto.
` ~.
ITNESS ITNESS
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Martha E. Serviente, the testatrix, whose name is
signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my last Will; that I
signed it willingly and as my free and voluntary act for the
purposes therein expressed.
/~
Martha E. Serviente
Sworn to or affirmed and acknowled before me by
Mart E. a iente, the testatrix, this day of
~~~~ , 2004.
.~ ~ -,,,.
NOTARIAL SEAL
STEPHEN J. HOGG, NOTARY PtI13~.i;. ~'~ *'
cARLtSLE soRO, CUMBERiAN® Ct3. 1~~ N dta ry Public/At
MY COMM18S1ON EXPIRES SEPTEMBER' ~, 2005
AFFIDAVIT
State of Pennsylvania
ss
County of Cumberland
~ l-
W ~ and I-~ ~ /'~ . ~~ l~ ~
the witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix
sign and execute the instrument as her last Will; that the
testatrix signed willingly and executed it as her free and
voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix
signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of
age, of sound mind and under no straint or undue
influence. t
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
.... _`
f,.:-
L___-
Sworn to or affirmed an
witnesses, this s~~day of _
NOTARIAL SEAL -
STEPHEN J. NOGG, (VOTARY PUBLIC N
CARLISLE BORO, CUMBERLAND CO., PA
MY COMMISSIpN EXPIRES SEPTEMBER 3, 2005
' to before me by
rv. , 2004.
.~~.~
ublic/Attorney